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Objectives The purpose of this study is to compare the reproducibility of three-dimensional cephalometric landmarks on three-dimensional computed tomography (3D-CT) surface rendering using clinical protocols based on low-dose (35-mAs) spiral CT and cone-beam CT (I-CAT). The absorbed dose levels for radiosensitive organs in the maxillofacial region during exposure in both 3D-CT protocols were also assessed. Materials and methods The study population consisted of ten human dry skulls examined with low-dose CT and cone-beam CT. Two independent observers identified 24 cephalometric anatomic landmarks at 13 sites on the 3D-CT surface renderings using both protocols, with each observer repeating the identification 1 month later. A total of 1,920 imaging measurements were performed. Thermoluminescent dosimeters were placed at six sites around the thyroid gland, the submandibular glands, and the eyes in an Alderson phantom to measure the absorbed dose levels. Results When comparing low-dose CT and cone-beam CT protocols, the cone-beam CT protocol proved to be significantly more reproducible for four of the 13 anatomical sites. There was no significant difference between the protocols for the other nine anatomical sites. Both low-dose and cone-beam CT protocols were equivalent in dose absorption to the eyes and submandibular glands. However, thyroid glands were more irradiated with low-dose CT. Conclusions Cone-beam CT was more reproducible and procured less irradiation to the thyroid gland than low-dose CT. Clinical relevance Cone-beam CT should be preferred over low-dose CT for developing three-dimensional bony cephalometric analyses.

Our objective was to compare mortality, epidemiology, and morbidity in hospitalized patients with candidemia which was both related and unrelated to the central venous catheter (CVC). This was a monocentric, retrospective cohort study of candidemia. The sample consisted of 103 patients with laboratory-confirmed nosocomial candidemia hospitalized between 2006 and 2013 in a tertiary care public hospital. We included 65 (63.1 %) patients (24 in the CVC-positive group, 41 in the CVC-negative group). Demographic data and risk factors were recorded using a structured case report form. In the group of candidemia associated to the CVC, survival at day 50 was 58.6 ± 11.9 %, compared to 26.5 ± 8.9 % for the CVC-negative group ( p -value = 0.012); the hazard ratio of death was 0.38 (95 % confidence interval 0.17–0.85, p -value = 0.019). Compared with the CVC-positive patients, CVC-negative patients were often colonized with yeast (41.5 % vs. 16.7 %, p -value = 0.041), had a shorter previous in-hospital stay (20 days vs. 34 days, p -value = 0.023), and were more severely ill (severe sepsis 85.4 % vs. 58.3 %, p -value = 0.016). In this study, when the origin of candidemia was not the CVC, patients were more seriously ill, had a higher mortality rate, and the removal of the catheter seemed to lead to disappointing results. It would be useful to explore the impact of retention of the CVC on survival in the CVC-negative patients, where the CVCs are essential to treating these patients.

Background Children with Prader-Willi Syndrome (PWS) have been considered at risk for central adrenal insufficiency (CAI). Hypothalamic dysregulation has been proposed as a common mechanism underlying both stress-induced CAI and central respiratory dysfunction during sleep. Objective To evaluate CAI and sleep-related breathing disorders in PWS children. Patients and methods Retrospective study of cortisol response following either insulin tolerance test (ITT) or glucagon test (GT) in 20 PWS children, and comparison with 33 non- Growth Hormone deficient (GHD) controls. Correlation between sleep related breathing disorders and cortisol response in 11 PWS children who received both investigations. Results In PWS children, the cortisol peak value showed a significant, inverse correlation with age (Kendall’s τ = -0.411; p  = 0.012). A similar though non-significant correlation was present between cortisol increase and age (τ = -0.232; p  = 0.16). Similar correlations were found in controls. In only 1 of 20 PWS children (5 %), ITT was suggestive of CAI. Four patients had an elevated central apnea index but they all exhibited a normal cortisol response. No relationship was found between peak cortisol or cortisol increase and central apnea index (respectively p  = 0.94 and p  = 0.14) or the other studied polysomnography (PSG) parameters. Conclusions CAI assessed by ITT/GT is rare in PWS children. Our data do not support a link between CAI and central respiratory dysregulation.

Objectives One of the key aspects of three-dimensional (3D) craniofacial cephalometry is the measurement of posterior cranial base angle as this area is deeply involved in craniofacial development. The purpose of our retrospective study was to define the best reproducible 3D posterior cranial base angles among five 3D angles transposed from 2D cephalometry (Cousin, BL1 of Ross and Ravosa, Bjork, Delaire, CBA4 of Liberman) and seven 3D angles based on physical anthropology studies and on new concepts (R1 to R7). The null hypothesis was that all 3D posterior cranial base angles were equally reproducible. Material and methods We used a preoperative low-dose computed tomography (CT) data from 20 adult patients undergoing orthognathic surgery after approval by local ethical committee. Two independent observers performed two series of 23 3D landmark identifications on 3D CT surface rendering of each patient using Maxilim software. Then, the same observers performed twice 3D cephalometric analyses (23 landmarks, 4 midpoints, 19 planes) that provided the automatic measurement of 12 posterior cranial base angles. Results Inter-observer correlation coefficient varied from 0.545 (Cousin) to 0.695 (CBA4 of Liberman) and from −0.177 (R2) to 0.827 (R4). Conclusions The null hypothesis was rejected. The most reproducible angle was 3D angle R4 based on “basion,” “superior optic” (right, left), and “crista galli inferior” landmarks. Clinical relevance R4 angle might be used as reference 3D posterior cranial base angle in further clinical studies involving 3D cephalometry as a diagnostic tool for orthodontics and for orthognathic surgery.

Background: S100 A2 and hnRNP A2/B1 (heterogeneous ribonucleoprotein A2/B1) with its splicing variant hnRNP B1 are proteins which are involved in cellular proliferation, differentiation and protein synthesis and are up-regulated in non-small cell lung cancer (NSCLC). Since previous studies using paraffin-embedded tissues indicated a high potential of these markers for diagnosis and screening the present analysis intended to validate these data applying cryostat sections. Methods: 78 tumor-infiltrated lung cancer specimens and 66 adjacent histologically tumor-free tissues were analyzed; 11 autopsy specimens from patients who did not suffer from a malignant disease served as a control group. Cryostat sections were stained with monoclonal antibodies against hnRNP A2/B1, hnRNP B1 and S100 A2 and were compared with the previously established immunohistochemical profile of the same patients including EGFR, EGFRvIII, pEGFR, c-erbB-2, c-erbB-3, p53, Ki-67, bcl-2, p120 and microvessel density. Furthermore, these results were correlated with clinical parameters. Results: Expression of hnRNP A2/B1, hnRNP B1 and S100 A2 was increased in the tumor group when compared with the microscopic tumor-free specimens in 10% versus 5% (n.s.), 91% versus 5% and 65% versus 6%, respectively. Increased S100 and A2 hnRNP A2/B1 expressions were negative prognostic factors. With the exception of an increased EGFR expression in hnRNP A2/B1 negative cases the three analyzed markers did not correlate with the immunohistochemical parameters tested previously. Conclusion: Comparison between tumor probes and tumor-free specimens of NSCLC patients failed to approve the diagnostic relevance of hnRNP A2/B1 shown in previous studies, whereas hnRNP B1 revealed a high tumor specificity that could be helpful for tumor cell screening. Moreover, S100 A2 and hnRNP A2/B1 confirmed to be valuable prognostic parameters.

Background Prader-Willi syndrome (PWS) is a rare genetic neurodevelopmental disorder with different nutritional phases from suckling deficit with failure to thrive to early onset of obesity. Hyperghrelinemia has been described in PWS long before the development of obesity. Ghrelin is found in both acylated (AG) and unacylated (UAG) forms in the circulation. In contrast to AG, UAG has been shown to inhibit food intake and to be elevated in anorexia nervosa. The present project is aiming to determine the underlying mechanisms driving the different nutritional phases in PWS. Methods Measurement of at least 4 h-fasting plasma acylated and unacylated ghrelin in 37 infants with a genetic diagnosis of PWS aged from 1 month to 4 years and in 100 age-matched controls without endocrine disorder recruited prior to minor surgery. One blood sampling was analysed for each patient/control and clinical data were recorded. Eleven PWS infants underwent repetitive blood samples at 3 or 6-month intervals during routine visits. Results In infants with PWS, AG is not elevated ( p  = 0.45), UAG is significantly higher ( p  = 0.0044; confidence interval 1.06;1.33) resulting in a low AG/UAG ratio ( p  = 0.0056; confidence interval 0.76;0.95) compared to controls. Conclusion Unlike children and adults with PWS that have high AG and AG/UAG ratio, infants with PWS have elevated UAG that supports the concept of anorexia in the early phases of the disease. The change in AG/UAG ratio possibly drives the switch from failure to thrive to obesity. Clinical trial registration NCT02529085 .

The blood smear of the patient analysed on Cellavision (DM96) showed no eosinophilia, but enlarged red blood cells containing different stages of P. vivax, accounting for approximately 30% of the initial total white blood cell count.

Brucella endocarditis, although a rare complication of brucellosis, is the main cause of death related to this disease. This report describes a case of aortic endocarditis due to Brucella abortus in an elderly farmer with known aortic stenosis. Urgent valve replacement was performed because of progressive heart failure despite appropriate antimicrobial treatment. The infection was cured with trimethoprim-sulfamethoxazole and rifampin given for 3 months after surgery. A review of the literature reports on the 38 other cases of cured brucella endocarditis made clear the need for combined antimicrobial treatment and surgical valve replacement.

Antimicrobial therapy for 428 episodes of bacteremia in an 850-bed university hospital was prospectively evaluated for 1 year to measure the impact of two factors—blood culture results and the therapy chosen by infectious diseases specialists (IDSs)—on quality of treatment and outcome. Initial shock, a simplified acute physiology score of >15, and inappropriateness of the empirical treatment were independently associated with increased mortality. Empirical treatment was appropriate in 63% of the episodes. This proportion reached 78% for the episodes treated by IDSs, compared with 54% for the others (P < .001). After availability of blood culture results, the proportion of appropriate treatments increased to 94%, with 97% for IDS-treated patients and 89% for other patients (P = .008). IDSs more frequently shifted to oral antibiotics and used fewer broad-spectrum drugs. This study underlines the impact of blood culture results and of IDSs on the prescription of appropriate treatment for bacteremia and on the better use of antimicrobial drugs.